UDFF and Auto pSWE accurately assess liver steatosis and fibrosis risk in obese patients with MASLD

Abstract

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to fibrosis and cirrhosis. Fibrosis and steatosis assessment with vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) requires a dedicated device and time to obtain ≥10 reliable measurements. Auto pSWE allows for the simultaneous collection of 15 ARFI-based liver stiffness measurements (LSM) and UDFF-based steatosis assessment in a single acquisition.

Methods

This prospective study included patients undergoing liver biopsy, primarily during bariatric surgery, between 11/2021–12/2023. Paired LSM by Auto pSWE/VCTE and steatosis assessments by UDFF/CAP were performed within a median of 1 day before or after biopsy.

Results

134 patients (65% women, mean age: 42.6±13.3 years) with a high prevalence of obesity (mean BMI: 42.7±10.4; MASLD etiology: 88%) were included. Liver biopsy showed significant fibrosis (≥F2) in 27% of patients and moderate steatosis (≥S2) in 51%. A single 1×15 Auto pSWE acquisition and one UDFF measurement were as accurate as the median of 5 measurements. Auto pSWE (AUC: ≥F2=0.58, ≥F3=0.96, F4=0.97) and VCTE (AUC: ≥F2=0.60, ≥F3=0.92, F4=0.93) demonstrated high accuracy for advanced fibrosis stages. UDFF (AUC: ≥S1=0.79, ≥S2=0.78, S3=0.67) and CAP showed similar diagnostic accuracy.

Conclusion

Auto pSWE and UDFF provide accurate, noninvasive tests for advanced liver fibrosis and steatosis in MASLD, even in severely obese patients. Notably, Auto pSWE captures 15 LSM with UDFF in a single acquisition, saving time and eliminating the need for a dedicated device.

Zusammenfassung

Hintergrund

Die mit Stoffwechselstörungen assoziierte steatotische Lebererkrankung (Metabolic dysfunction-associated steatotic liver disease; MASLD) kann zu Fibrose und Zirrhose führen. Die nicht-invasive Beurteilung von Fibrose und Steatose mittels vibrationskontrollierter transienter Elastografie (VCTE) und Controlled-Attenuation-Parameter-(CAP-)Technologie erfordert ein spezielles Gerät und mindestens 10 verlässliche Messungen. Die ultraschall-basierte Fettfraktion (UDFF) und die Auto-Punkt-Scherwelle (Auto-pSWE) ermöglichen eine Quantifizierung von Lebersteatose und -fibrose in nur einer Akquisition.

Methoden

Diese prospektive Studie umfasste Patient:innen, die zwischen 11/2021 und 12/2023 eine Leberbiopsie erhielten. Paarweise Lebersteifigkeits- und Steatosemessungen durch Auto pSWE/UDFF und VCTE/CAP wurden einen Tag vor oder nach der Leberbiopsie durchgeführt.

Ergebnisse

134 Patient:innen mit hoher Adipositas-Prävalenz wurden eingeschlossen. Eine einzige Akquisition (welche 15 pSWE-Messungen erfasst) durch Auto-pSWE lieferte dieselbe diagnostische Genauigkeit wie der Median aus 5 Messungen. Auto-pSWE (≥F2, AUC=0,58; ≥F3, AUC=0,96; F4, AUC=0,97) und VCTE zeigten eine hohe diagnostische Genauigkeit für die Erfassung einer fortgeschrittenen Fibrose. Die Diagnosegenauigkeit von UDFF (≥S1, AUC=0,79; ≥S2, AUC=0,78) war vergleichbar mit CAP.

Schlussfolgerung

Auto pSWE und UDFF sind präzise, nicht-invasive Methoden zur Diagnostik fortgeschrittener Leberfibrose und -steatose bei Patient:innen mit MASLD. Die simultane Erfassung von 15 pSWE-Messungen und UDFF in einer Akquisition ist zeitsparend und erfordert kein spezielles Gerät.

Keywords

Point of care - Education, Training, Quality Assurance - MASLD - Auto pSWE - UDFF

Publication History

Received: 07 November 2024

Accepted after revision: 16 April 2025

Article published online:
07 August 2025

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